An 83-year-old white man was referred with multiple nodules on the scalp that had appeared 3 months earlier. The nodules were growing rapidly.

He had painless, erythematous, dome-shaped nodules on the scalp. The nodules ranged from 4 × 4 to 10 × 15 mm in diameter (Figure 1). An incisional biopsy specimen revealed small and round cells disposed in a trabecular pattern. Immunohistochemical analysis revealed strong positivity for cytokeratin 20 and neurofilament. On the basis of the histopathologic and immunohistochemical features, Merkel cell carcinoma (MCC) was diagnosed.